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Rhode Island Senate Bill S0563

Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0563 Compare Versions

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99 S TATE OF RHODE IS LAND
1010 IN GENERAL ASSEMBLY
1111 JANUARY SESSION, A.D. 2023
1212 ____________
1313
1414 A N A C T
1515 RELATING TO INSURANCE -- INSURANCE COVERAGE FOR PREVENT ION OF HIV
1616 INFECTION
1717 Introduced By: Senators Murray, Valverde, Lauria, Pearson, Euer, Lawson, Mack,
1818 Acosta, Miller, and Cano
1919 Date Introduced: March 07, 2023
2020 Referred To: Senate Health & Human Services
2121
2222
2323 It is enacted by the General Assembly as follows:
24-"SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness 1
25-Insurance Policies" is hereby amended by adding thereto the following sections: 2
26-27-18-91. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the 3
27-prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. 4
28-(a) Every group health insurance contract, or every group hospital or medical expense 5
29-insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 6
30-any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of 7
31-pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis 8
32-(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall 9
33-constitute a separate method of administration. A health insurer is not required to cover any 10
34-preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an 11
35-out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network 12
36-pharmacy benefit. 13
37-(b) The healthcare benefits outlined in this chapter apply only to services delivered within 14
38-the health insurer’s provider network; provided that, all health insurers shall be required to provide 15
39-coverage for those benefits mandated by this chapter outside of the health insurer’s provider 16
40-network where it can be established that the required services are not available from a provider in 17
41-the health insurer’s network. 18
24+SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended by 1
25+adding thereto the following chapter: 2
26+CHAPTER 38.3 3
27+INSURANCE COVERAGE FOR PREVENTION OF HIV INFECTION 4
28+27-38.3-1. Coverage for prevention of HIV infection. 5
29+(a) A group health plan and an individual or group health insurance plan shall provide 6
30+coverage for the prevention treatment of HIV infection under the same terms and conditions as that 7
31+coverage is provided for other illnesses and diseases. 8
32+(b) Coverage for the prevention treatment of HIV infection shall not impose any annual or 9
33+lifetime dollar limitation. 10
34+(c) Financial requirements and quantitative treatment limitations on coverage for the 11
35+prevention treatment of HIV infection shall be no more restrictive than the predominant financial 12
36+requirements applied to substantially all coverage for medical conditions in each treatment 13
37+classification. 14
38+(d) Coverage shall not impose non-quantitative treatment limitations for the prevention 15
39+treatment of HIV infection unless the processes, strategies, evidentiary standards, or other factors 16
40+used in applying the non-quantitative treatment limitation, as written and in operation, are 17
41+comparable to, and are applied no more stringently than, the processes, strategies, evidentiary 18
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45-27-18-92. Expedited Prior Authorization. 1
46-To the extent a prior authorization is permitted and applied, then it shall be conducted in 2
47-an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-3
48-18.9-6(a)(1). 4
49-27-18-93. Dispensing and Administration of HIV PrEP or PEP Drugs. 5
50-(a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 6
51-Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 7
52-subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 8
53-PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a) 9
54-pursuant to a standing order or collaborative practice agreement or to protocols developed by the 10
55-board for when there is no prescription drug order, standing order or collaborative practice 11
56-agreement in accordance with the requirements in this subsection and may also order laboratory 12
57-testing for HIV infection as necessary. 13
58-(b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 14
59-training program approved by the board on the use of protocols developed by the board for 15
60-prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 16
61-laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 17
62-to counsel patients prescribed an HIV prevention drug. 18
63-(c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 19
64-day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 20
65-(1) The patient tests negative for HIV infection, as documented by a negative HIV test 21
66-result obtained within the previous seven (7) days. If the patient does not provide evidence of a 22
67-negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted 23
68-directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. 24
69-If the patient tests positive for HIV infection, the pharmacist or person administering the test shall 25
70-direct the patient to a primary care provider and provide a list of primary care providers and clinics 26
71-within a reasonable travel distance of the patient's residence; 27
72-(2) The patient does not report any signs or symptoms of acute HIV infection on a self-28
73-reporting checklist of acute HIV infection signs and symptoms; 29
74-(3) The patient does not report taking any contraindicated medications; 30
75-(4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 31
76-the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 32
77-be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 33
78-that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 34
44+LC001940 - Page 2 of 8
45+standards, or other factors used in applying the limitation with respect to medical/surgical benefits 1
46+in the classification. 2
47+(e) The following classifications shall be used to apply the coverage requirements of this 3
48+chapter: 4
49+(1) Inpatient, in-network; 5
50+(2) Inpatient, out-of-network; 6
51+(3) Outpatient, in-network; 7
52+(4) Outpatient, out-of-network; 8
53+(5) Emergency care; and 9
54+(6) Prescription drugs. 10
55+(f) Payors shall rely upon the criteria of the Society of Infectious Diseases Pharmacists 11
56+when developing coverage for levels of care for HIV prevention treatment. 12
57+27-38.3-2. Definitions. 13
58+As used in this section, unless the context otherwise indicates, the following terms have 14
59+the following meanings: 15
60+(1) "CDC guidelines" means guidelines related to the nonoccupational exposure to 16
61+potential HIV infection, or any subsequent guidelines, published by the federal Department of 17
62+Health and Human Services, Centers for Disease Control and Prevention. 18
63+(2) "Financial requirements" means deductibles, copayments, coinsurance, or out-of-19
64+pocket maximums. 20
65+(3) "Group health plan" means an employee welfare benefit plan as defined in 29 U.S.C. § 21
66+1002(1) to the extent that the plan provides health benefits to employees or their dependents directly 22
67+or through insurance, reimbursement, or otherwise. For purposes of this chapter, a group health 23
68+plan shall not include a plan that provides health benefits directly to employees or their dependents, 24
69+except in the case of a plan provided by the state or an instrumentality of the state. 25
70+(4) "Health insurance plan" means health insurance coverage offered, delivered, issued for 26
71+delivery, or renewed by a health insurer. 27
72+(5) "Health insurers" means all persons, firms, corporations, or other organizations offering 28
73+and assuring health services on a prepaid or primarily expense-incurred basis, including, but not 29
74+limited to, policies of accident or sickness insurance, as defined by chapter 18 of this title; nonprofit 30
75+hospital or medical service plans, whether organized under chapter 19 or 20 of this title or under 31
76+any public law or by special act of the general assembly; health maintenance organizations, or any 32
77+other entity that insures or reimburses for diagnostic, therapeutic, or preventive services to a 33
78+determined population on the basis of a periodic premium. Provided, this chapter does not apply to 34
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82-PEP drug to a single patient once every two (2) years without a prescription; 1
83-(5) The pharmacist documents, to the extent possible, the services provided by the 2
84-pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 3
85-The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 4
86-patient; 5
87-(6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 6
88-PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 7
89-practitioner; and 8
90-(7) The pharmacist notifies the patient's primary care provider that the pharmacist 9
91-completed the requirements specified in this subsection. If the patient does not have a primary care 10
92-provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 11
93-provide the patient a list of physicians, clinics or other health care providers to contact regarding 12
94-follow-up care. 13
95-(d) A pharmacist shall dispense or administer a complete course of a post-exposure 14
96-prophylaxis drug as long as all of the following conditions are met: 15
97-(1) The pharmacist screens the patient and determines that the exposure occurred within 16
98-the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post 17
99-exposure prophylaxis drug under CDC guidelines; 18
100-(2) The pharmacist provides HIV testing to the patient or determines that the patient is 19
101-willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 20
102-HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 21
103-the pharmacist may dispense or administer a post-exposure prophylaxis drug; 22
104-(3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 23
105-the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 24
106-availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 25
107-(4) The pharmacist notifies the patient's primary care provider of the dispensing or 26
108-administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 27
109-provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 28
110-provide the patient a list of physicians, clinics or other health care providers to contact regarding 29
111-follow-up care. 30
112-(e) The board shall promulgate rules and regulations establishing standards for authorizing 31
113-pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 32
114-section, including adequate training requirements and protocols for when there is no prescription 33
115-drug order, standing order or collaborative practice agreement. 34
81+LC001940 - Page 3 of 8
82+insurance coverage providing benefits for: 1
83+(i) Hospital confinement indemnity; 2
84+(ii) Disability income; 3
85+(iii) Accident only; 4
86+(iv) Long-term care; 5
87+(v) Medicare supplement; 6
88+(vi) Limited benefit health; 7
89+(vii) Specific disease indemnity; 8
90+(viii) Sickness or bodily injury or death by accident or both; and 9
91+(ix) Other limited benefit policies. 10
92+(6) "HIV prevention drug" means a preexposure prophylaxis drug, post-exposure 11
93+prophylaxis drug or other drug approved for the prevention of HIV infection by the federal Food 12
94+and Drug Administration. 13
95+(7) "Non-quantitative treatment limitations" means: 14
96+(i) Medical management standards; 15
97+(ii) Formulary design and protocols; 16
98+(iii) Network tier design; 17
99+(iv) Standards for provider admission to participate in a network; 18
100+(v) Reimbursement rates and methods for determining usual, customary, and reasonable 19
101+charges; and 20
102+(vi) Other criteria that limit scope or duration of coverage for services in the prevention 21
103+treatment of HIV infection, including restrictions based on geographic location, facility type, and 22
104+provider specialty. 23
105+(8) "Post-exposure prophylaxis drug" means a drug or drug combination that meets the 24
106+clinical eligibility recommendations provided in CDC guidelines following potential exposure to 25
107+HIV infection. 26
108+(9) "Preexposure prophylaxis drug" means a drug or drug combination that meets the 27
109+clinical eligibility recommendations provided in CDC guidelines to prevent HIV infection. 28
110+(10) "Quantitative treatment limitations" means numerical limits on coverage for the 29
111+preventive treatment of HIV infection based on the frequency of treatment, number of visits, days 30
112+of coverage, days in a waiting period, or other similar limits on the scope or duration of treatment. 31
113+27-38.3-3. Coverage required. 32
114+A health insurer offering a health plan in this state shall provide coverage for an HIV 33
115+prevention drug that has been prescribed by a provider. Coverage under this section is subject to 34
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118-LC001940/SUB A/2 - Page 4 of 15
119-SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 1
120-Corporations" is hereby amended by adding thereto the following sections: 2
121-27-19-83. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the 3
122-prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. 4
123-(a) Every group health insurance contract, or every group hospital or medical expense 5
124-insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 6
125-any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of 7
126-pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis 8
127-(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall 9
128-constitute a separate method of administration. A health insurer is not required to cover any 10
129-preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an 11
130-out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network 12
131-pharmacy benefit. 13
132-(b) The healthcare benefits outlined in this chapter apply only to services delivered within 14
133-the health insurer’s provider network; provided that, all health insurers shall be required to provide 15
134-coverage for those benefits mandated by this chapter outside of the health insurer’s provider 16
135-network where it can be established that the required services are not available from a provider in 17
136-the health insurer’s network. 18
137-27-19-84. Expedited Prior Authorization. 19
138-To the extent a prior authorization is permitted and applied, then it shall be conducted in 20
139-an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-21
140-18.9-6(a)(1). 22
141-27-19-85. Dispensing and Administration of HIV PrEP or PEP Drugs. 23
142-(a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 24
143-Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 25
144-subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 26
145-PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a) 27
146-pursuant to a standing order or collaborative practice agreement or to protocols developed by the 28
147-board for when there is no prescription drug order, standing order or collaborative practice 29
148-agreement in accordance with the requirements in this subsection and may also order laboratory 30
149-testing for HIV infection as necessary. 31
150-(b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 32
151-training program approved by the board on the use of protocols developed by the board for 33
152-prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 34
118+LC001940 - Page 4 of 8
119+the following; 1
120+(1) If the federal Food and Drug Administration has approved one or more HIV prevention 2
121+drugs that use the same method of administration, a health insurer is not required to cover all 3
122+approved drugs as long as the insurer covers at least one approved drug for each method of 4
123+administration with no out-of-pocket cost. 5
124+(2) A health insurer is not required to cover any preexposure prophylaxis drug or post-6
125+exposure prophylaxis drug dispensed or administered by an out-of-network pharmacy provider 7
126+unless the enrollee's health plan provides an out-of-network pharmacy benefit. 8
127+(3) A health insurer shall not prohibit or permit a pharmacy benefits manager to prohibit a 9
128+pharmacy provider from dispensing or administering any HIV prevention drugs. 10
129+27-38.3-4. Limits on prior authorization and step therapy requirements. 11
130+Notwithstanding any requirements to the contrary, a health insurer shall not subject any 12
131+HIV prevention drug to any prior authorization or step therapy requirement except as provided in 13
132+this section. If the federal Food and Drug Administration has approved one or more methods of 14
133+administering HIV prevention drugs, an insurer is not required to cover all of the approved drugs 15
134+without prior authorization or step therapy requirements as long as the insurer covers at least one 16
135+approved drug for each method of administration without prior authorization or step therapy 17
136+requirements. If prior authorization or step therapy requirements are met for a particular enrollee 18
137+with regard to a particular HIV prevention drug, the insurer is required to cover that drug with no 19
138+out-of-pocket cost to the enrollee. 20
139+27-38.3-5. Coverage for laboratory testing related to HIV prevention drugs. 21
140+A health insurer offering a health plan in this state shall provide coverage with no out-of-22
141+pocket cost for laboratory testing recommended by a provider related to the ongoing monitoring of 23
142+an enrollee who is taking an HIV prevention drug covered by this chapter. 24
143+27-38.3-6. Medical necessity and appropriateness of treatment. 25
144+(a) Upon request of the reimbursing health insurers, all providers of prevention treatment 26
145+of HIV infection shall furnish medical records or other necessary data which substantiates that 27
146+initial or continued treatment is at all times medically necessary and/or appropriate. When the 28
147+provider cannot establish the medical necessity and/or appropriateness of the treatment modality 29
148+being provided, neither the health insurer nor the patient shall be obligated to reimburse for that 30
149+period or type of care that was not established. Exception to the preceding requirement can only be 31
150+made if the patient has been informed of the provisions of this subsection and has agreed in writing 32
151+to continue to receive treatment at their own expense. 33
152+(b) The health insurers, when making the determination of medically necessary and 34
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155-LC001940/SUB A/2 - Page 5 of 15
156-laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 1
157-to counsel patients prescribed an HIV prevention drug. 2
158-(c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 3
159-day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 4
160-(1) The patient tests negative for HIV infection, as documented by a negative HIV test 5
161-result obtained within the previous seven (7) days. If the patient does not provide evidence of a 6
162-negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted 7
163-directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. 8
164-If the patient tests positive for HIV infection, the pharmacist or person administering the test shall 9
165-direct the patient to a primary care provider and provide a list of primary care providers and clinics 10
166-within a reasonable travel distance of the patient's residence; 11
167-(2) The patient does not report any signs or symptoms of acute HIV infection on a self-12
168-reporting checklist of acute HIV infection signs and symptoms; 13
169-(3) The patient does not report taking any contraindicated medications; 14
170-(4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 15
171-the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 16
172-be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 17
173-that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 18
174-PEP drug to a single patient once every two (2) years without a prescription; 19
175-(5) The pharmacist documents, to the extent possible, the services provided by the 20
176-pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 21
177-The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 22
178-patient; 23
179-(6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 24
180-PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 25
181-practitioner; and 26
182-(7) The pharmacist notifies the patient's primary care provider that the pharmacist 27
183-completed the requirements specified in this subsection. If the patient does not have a primary care 28
184-provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 29
185-provide the patient a list of physicians, clinics or other health care providers to contact regarding 30
186-follow-up care. 31
187-(d) A pharmacist shall dispense or administer a complete course of a post-exposure 32
188-prophylaxis drug as long as all of the following conditions are met: 33
189-(1) The pharmacist screens the patient and determines that the exposure occurred within 34
155+LC001940 - Page 5 of 8
156+appropriate treatment, shall do so in a manner consistent with that used to make the determination 1
157+for the treatment of other diseases or injuries covered under the health insurance policy or 2
158+agreement. 3
159+(c) Any subscriber who is aggrieved by a denial of benefits provided under this chapter 4
160+may appeal a denial in accordance with the rules and regulations promulgated by the department 5
161+of health pursuant to chapter 17.12 of title 23. 6
162+27-38.3-7. Network coverage. 7
163+The healthcare benefits outlined in this chapter apply only to services delivered within the 8
164+health insurer’s provider network; provided that, all health insurers shall be required to provide 9
165+coverage for those benefits mandated by this chapter outside of the health insurer’s provider 10
166+network where it can be established that the required services are not available from a provider in 11
167+the health insurer’s network. 12
168+SECTION 2. Chapter 5-19.1 of the General Laws entitled "Pharmacies" is hereby amended 13
169+by adding thereto the following section: 14
170+5-19.1-31.1. Prescribing, dispensing and administering HIV prevention drugs. 15
171+(a) Definitions. As used in this section, unless the context otherwise indicates, the 16
172+following terms have the following meanings. 17
173+(1) "CDC guidelines" means guidelines related to nonoccupational exposure to potential 18
174+HIV infection, or any subsequent guidelines, published by the federal Department of Health and 19
175+Human Services, Centers for Disease Control and Prevention. 20
176+(2) "HIV prevention drug" means a preexposure prophylaxis drug, post-exposure 21
177+prophylaxis drug or other drug approved for the prevention of HIV infection by the federal Food 22
178+and Drug Administration. 23
179+(3) "Post-exposure prophylaxis drug" means a drug or drug combination that meets the 24
180+clinical eligibility recommendations provided in CDC guidelines following potential exposure to 25
181+HIV infection. 26
182+(4) "Preexposure prophylaxis drug" means a drug or drug combination that meets the 27
183+clinical eligibility recommendations provided in CDC guidelines to prevent HIV infection. 28
184+(b) Authorization. Notwithstanding any provision of law to the contrary and as authorized 29
185+by the board in accordance with rules and regulations adopted under subsection (c) of this section, 30
186+a pharmacist may prescribe, dispense and administer HIV prevention drugs pursuant to a standing 31
187+order or collaborative practice agreement or to protocols developed by the board for when there is 32
188+no prescription drug order, standing order or collaborative practice agreement in accordance with 33
189+the requirements in this subsection and may also order laboratory testing for HIV infection as 34
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192-LC001940/SUB A/2 - Page 6 of 15
193-the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post 1
194-exposure prophylaxis drug under CDC guidelines; 2
195-(2) The pharmacist provides HIV testing to the patient or determines that the patient is 3
196-willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 4
197-HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 5
198-the pharmacist may dispense or administer a post-exposure prophylaxis drug; 6
199-(3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 7
200-the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 8
201-availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 9
202-(4) The pharmacist notifies the patient's primary care provider of the dispensing or 10
203-administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 11
204-provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 12
205-provide the patient a list of physicians, clinics or other health care providers to contact regarding 13
206-follow-up care. 14
207-(e) The board shall promulgate rules and regulations establishing standards for authorizing 15
208-pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 16
209-section, including adequate training requirements and protocols for when there is no prescription 17
210-drug order, standing order or collaborative practice agreement. 18
211-SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 19
212-Corporations" is hereby amended by adding thereto the following sections: 20
213-27-20-79. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the 21
214-prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. 22
215-(a) Every group health insurance contract, or every group hospital or medical expense 23
216-insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 24
217-any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of 25
218-pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis 26
219-(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall 27
220-constitute a separate method of administration. A health insurer is not required to cover any 28
221-preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an 29
222-out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network 30
223-pharmacy benefit. 31
224-(b) The healthcare benefits outlined in this chapter apply only to services delivered within 32
225-the health insurer’s provider network; provided that, all health insurers shall be required to provide 33
226-coverage for those benefits mandated by this chapter outside of the health insurer’s provider 34
192+LC001940 - Page 6 of 8
193+necessary. 1
194+(i) Before furnishing an HIV prevention drug to a patient, a pharmacist shall complete a 2
195+training program approved by the board on the use of protocols developed by the board for 3
196+prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 4
197+laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 5
198+to counsel patients prescribed an HIV prevention drug. 6
199+(ii) A pharmacist shall dispense or administer a preexposure prophylaxis drug in at least a 7
200+thirty (30) day supply, and up to a sixty (60) day supply, as long as all of the following conditions 8
201+are met: 9
202+(A) The patient tests negative for HIV infection, as documented by a negative HIV test 10
203+result obtained within the previous seven (7) days. If the patient does not provide evidence of a 11
204+negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted 12
205+directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. 13
206+If the patient tests positive for HIV infection, the pharmacist or person administering the test shall 14
207+direct the patient to a primary care provider and provide a list of primary care providers and clinics 15
208+within a reasonable travel distance of the patient's residence; 16
209+(B) The patient does not report any signs or symptoms of acute HIV infection on a self-17
210+reporting checklist of acute HIV infection signs and symptoms; 18
211+(C) The patient does not report taking any contraindicated medications; 19
212+(D) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 20
213+the ongoing use of a preexposure prophylaxis drug. The pharmacist shall notify the patient that the 21
214+patient shall be seen by a primary care provider to receive subsequent prescriptions for a 22
215+preexposure prophylaxis drug and that a pharmacist shall not dispense or administer more than a 23
216+sixty (60) day supply of a preexposure prophylaxis drug to a single patient once every two (2) years 24
217+without a prescription; 25
218+(E) The pharmacist documents, to the extent possible, the services provided by the 26
219+pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 27
220+The pharmacist shall maintain records of preexposure prophylaxis drugs dispensed or administered 28
221+to each patient; 29
222+(F) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 30
223+preexposure prophylaxis drug to a single patient once every two (2) years, unless otherwise directed 31
224+by a practitioner; and 32
225+(G) The pharmacist notifies the patient's primary care provider that the pharmacist 33
226+completed the requirements specified in this subsection. If the patient does not have a primary care 34
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229-LC001940/SUB A/2 - Page 7 of 15
230-network where it can be established that the required services are not available from a provider in 1
231-the health insurer’s network. 2
232-27-20-80. Expedited Prior Authorization. 3
233-To the extent a prior authorization is permitted and applied, then it shall be conducted in 4
234-an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant § 27-5
235-18.9-6(a)(1). 6
236-27-20-81. Dispensing and Administration of HIV PrEP or PEP Drugs. 7
237-(a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 8
238-Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 9
239-subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 10
240-PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a) 11
241-of this section pursuant to a standing order or collaborative practice agreement or to protocols 12
242-developed by the board for when there is no prescription drug order, standing order or collaborative 13
243-practice agreement in accordance with the requirements in this subsection and may also order 14
244-laboratory testing for HIV infection as necessary. 15
245-(b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 16
246-training program approved by the board on the use of protocols developed by the board for 17
247-prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 18
248-laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 19
249-to counsel patients prescribed an HIV prevention drug. 20
250-(c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 21
251-day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 22
252-(1) The patient tests negative for HIV infection, as documented by a negative HIV test 23
253-result obtained within the previous seven (7) days. If the patient does not provide evidence of a 24
254-negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted 25
255-directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. 26
256-If the patient tests positive for HIV infection, the pharmacist or person administering the test shall 27
257-direct the patient to a primary care provider and provide a list of primary care providers and clinics 28
258-within a reasonable travel distance of the patient's residence; 29
259-(2) The patient does not report any signs or symptoms of acute HIV infection on a self-30
260-reporting checklist of acute HIV infection signs and symptoms; 31
261-(3) The patient does not report taking any contraindicated medications; 32
262-(4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 33
263-the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 34
264-
265-
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267-be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 1
268-that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 2
269-PEP drug to a single patient once every two (2) years without a prescription; 3
270-(5) The pharmacist documents, to the extent possible, the services provided by the 4
271-pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 5
272-The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 6
273-patient; 7
274-(6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 8
275-PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 9
276-practitioner; and 10
277-(7) The pharmacist notifies the patient's primary care provider that the pharmacist 11
278-completed the requirements specified in this subsection. If the patient does not have a primary care 12
279-provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 13
280-provide the patient a list of physicians, clinics or other health care providers to contact regarding 14
281-follow-up care. 15
282-(d) A pharmacist shall dispense or administer a complete course of a post-exposure 16
283-prophylaxis drug as long as all of the following conditions are met: 17
284-(1) The pharmacist screens the patient and determines that the exposure occurred within 18
285-the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post 19
286-exposure prophylaxis drug under CDC guidelines; 20
287-(2) The pharmacist provides HIV testing to the patient or determines that the patient is 21
288-willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 22
289-HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 23
290-the pharmacist may dispense or administer a post-exposure prophylaxis drug; 24
291-(3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 25
292-the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 26
293-availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 27
294-(4) The pharmacist notifies the patient's primary care provider of the dispensing or 28
295-administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 29
296-provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 30
297-provide the patient a list of physicians, clinics or other health care providers to contact regarding 31
298-follow-up care. 32
299-(e) The board shall promulgate rules and regulations establishing standards for authorizing 33
300-pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 34
301-
302-
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304-section, including adequate training requirements and protocols for when there is no prescription 1
305-drug order, standing order to collaborative practice agreement. 2
306-SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 3
307-Organizations" is hereby amended by adding thereto the following sections: 4
308-27-41-96. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the 5
309-prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection. 6
310-(a) Every group health insurance contract, or every group hospital or medical expense 7
311-insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by 8
312-any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of 9
313-pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis 10
314-(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall 11
315-constitute a separate method of administration. A health insurer is not required to cover any 12
316-preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an 13
317-out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network 14
318-pharmacy benefit. 15
319-(b) The healthcare benefits outlined in this chapter apply only to services delivered within 16
320-the health insurer’s provider network; provided that, all health insurers shall be required to provide 17
321-coverage for those benefits mandated by this chapter outside of the health insurer’s provider 18
322-network where it can be established that the required services are not available from a provider in 19
323-the health insurer’s network. 20
324-27-41-97. Expedited Prior Authorization. 21
325-To the extent a prior authorization is permitted and applied, then it shall be conducted in 22
326-an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-23
327-18.9-6(a)(1). 24
328-27-41-98. Dispensing and Administration of HIV PrEP or PEP Drugs. 25
329-(a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode 26
330-Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under 27
331-subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or 28
332-PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a) 29
333-pursuant to a standing order or collaborative practice agreement or to protocols developed by the 30
334-board for when there is no prescription drug order, standing order or collaborative practice 31
335-agreement in accordance with the requirements in this subsection and may also order laboratory 32
336-testing for HIV infection as necessary. 33
337-(b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a 34
338-
339-
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341-training program approved by the board on the use of protocols developed by the board for 1
342-prescribing, dispensing and administering an HIV prevention drug, on the requirements for any 2
343-laboratory testing for HIV infection and on guidelines for prescription adherence and best practices 3
344-to counsel patients prescribed an HIV prevention drug. 4
345-(c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30) 5
346-day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met: 6
347-(1) The patient tests negative for HIV infection, as documented by a negative HIV test 7
348-result obtained within the previous seven (7) days. If the patient does not provide evidence of a 8
349-negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted 9
350-directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction. 10
351-If the patient tests positive for HIV infection, the pharmacist or person administering the test shall 11
352-direct the patient to a primary care provider and provide a list of primary care providers and clinics 12
353-within a reasonable travel distance of the patient's residence; 13
354-(2) The patient does not report any signs or symptoms of acute HIV infection on a self-14
355-reporting checklist of acute HIV infection signs and symptoms; 15
356-(3) The patient does not report taking any contraindicated medications; 16
357-(4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 17
358-the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall 18
359-be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and 19
360-that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or 20
361-PEP drug to a single patient once every two (2) years without a prescription; 21
362-(5) The pharmacist documents, to the extent possible, the services provided by the 22
363-pharmacist in the patient's record in the patient profile record system maintained by the pharmacy. 23
364-The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each 24
365-patient; 25
366-(6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a 26
367-PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a 27
368-practitioner; and 28
369-(7) The pharmacist notifies the patient's primary care provider that the pharmacist 29
370-completed the requirements specified in this subsection. If the patient does not have a primary care 30
371-provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 31
372-provide the patient a list of physicians, clinics or other health care providers to contact regarding 32
373-follow-up care. 33
374-(d) A pharmacist shall dispense or administer a complete course of a post-exposure 34
375-
376-
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378-prophylaxis drug as long as all of the following conditions are met: 1
379-(1) The pharmacist screens the patient and determines that the exposure occurred within 2
380-the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post 3
381-exposure prophylaxis drug under CDC guidelines; 4
382-(2) The pharmacist provides HIV testing to the patient or determines that the patient is 5
383-willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 6
384-HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 7
385-the pharmacist may dispense or administer a post-exposure prophylaxis drug; 8
386-(3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 9
387-the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 10
388-availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and 11
389-(4) The pharmacist notifies the patient's primary care provider of the dispensing or 12
390-administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 13
391-provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 14
392-provide the patient a list of physicians, clinics or other health care providers to contact regarding 15
393-follow-up care. 16
394-(e) The board shall promulgate rules and regulations establishing standards for authorizing 17
395-pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this 18
396-section, including adequate training requirements and protocols for when there is no prescription 19
397-drug order, standing order or collaborative practice agreement. 20
398-SECTION 5. Section 23-6.3-2 of the General Laws in Chapter 23-6.3 entitled "Prevention 21
399-and Suppression of Contagious Diseases - HIV/AIDS" is hereby amended to read as follows: 22
400-23-6.3-2. Definitions. 23
401-As used in this chapter the following words shall have the following meanings: 24
402-(1) "Agent" means a person empowered by the patient to assert or waive the confidentiality, 25
403-or to disclose or consent to the disclosure of confidential information, as established by chapter 26
404-37.3 of title 5, as amended, entitled "Confidentiality of Health Care Communications and 27
405-Information Act." 28
406-(2) "AIDS" means the medical condition known as acquired immune deficiency syndrome, 29
407-caused by infection of an individual by the human immunodeficiency virus (HIV). 30
408-(3) "Anonymous HIV testing" means an HIV test that utilizes a laboratory generated code 31
409-based system, which does not require an individual's name or other identifying information that 32
410-may reveal one's identity, including information related to the individual's health insurance policy, 33
411-to be associated with the test. 34
412-
413-
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415-(4) "Antibody" means a protein produced by the body in response to specific foreign 1
416-substances such as bacteria or viruses. 2
417-(5) "Community-based organization" means an entity that has written authorization from 3
418-the department for HIV counseling, testing and referral services (HIV CTRS). 4
419-(6) "Confidential HIV testing" means an HIV test that requires the individual's name and 5
420-other identifying information including information related to the individual's health insurance 6
421-policy, as appropriate. 7
422-(7) "Consent" means an explicit exchange of information between a person and a healthcare 8
423-provider or qualified professional HIV test counselor through which an informed individual can 9
424-choose whether to undergo HIV testing or decline to do so. Elements of consent shall include 10
425-providing each individual with verbal or written information regarding an explanation of HIV 11
426-infection, a description of interventions that can reduce HIV transmission, the meanings of positive 12
427-and negative test results, the voluntary nature of the HIV testing, an opportunity to ask questions 13
428-and to decline testing. 14
429-(8) "Controlled substance" means a drug, substance, or immediate precursor in schedules 15
430-I-V listed in the provisions of chapter 28 of title 21 entitled, "Uniform Controlled Substances Act." 16
431-(9) "Department" means the Rhode Island department of health. 17
432-(10) "Diagnosis of AIDS" means the most current surveillance case definition for AIDS 18
433-published in the Centers for Disease Control & Prevention (CDC). 19
434-(11) "Diagnosis of HIV" means the most current surveillance case definition for HIV 20
435-infection published in the CDC's (MMWR). 21
436-(12) "Director" means the director of the Rhode Island department of health. 22
437-(13) "ELISA result" means enzyme-linked immunosorbent assay or EIA (enzyme 23
438-immunoassay) which is a serologic technique used in immunology to detect the presence of either 24
439-antibody or antigen. 25
440-(14) "Health benefits" include accident and sickness, including disability or health 26
441-insurance, health benefit plans and/or policies, hospital, health, or medical service plans, or any 27
442-health maintenance organization plan pursuant to title 27 or otherwise. 28
443-(15) "Healthcare facility" means those facilities licensed by the department in accordance 29
444-with the provisions of chapter 17 of this title. 30
445-(16) "Healthcare provider," as used herein, means a licensed physician, physician assistant, 31
446-certified nurse practitioner, pharmacist or midwife. 32
447-(17) "Healthcare settings" means venues offering clinical STD services including, but not 33
448-limited to, hospitals, urgent care clinics, STD clinics and other substance abuse treatment facilities, 34
449-
450-
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452-mental health treatment facilities, community health centers, primary care and OB/GYN physician 1
453-offices, and family planning providers. 2
454-(18) "HIV" means the human immunodeficiency virus, the pathogenic organism 3
455-responsible for HIV infection and/or the acquired immunodeficiency syndrome (AIDS) in humans. 4
456-(19) "HIV CD4 T-lymphocyte test result" means the results of any currently medically 5
457-accepted and/or FDA approved test used to count CD4 T-lymphatic cells in the blood of an HIV-6
458-infected person. 7
459-(20) "HIV counseling" means an interactive process of communication between a person 8
460-and a healthcare provider or qualified professional HIV test counselor during which there is an 9
461-assessment of the person's risks for HIV infection and the provision of counseling to assist the 10
462-person with behavior changes that can reduce risks for acquiring HIV infection. 11
463-(21) "HIV screening" means the conduct of HIV testing among those who do not show 12
464-signs or symptoms of an HIV infection. 13
465-(22) "HIV test" means any currently medically accepted and/or FDA approved test for 14
466-determining HIV infection in humans. 15
467-(23) "Occupational health representative" means a person, within a healthcare facility, 16
468-trained to respond to occupational, particularly blood borne, exposures. 17
469-(24) "Opts out" means that a person who has been notified that a voluntary HIV test will 18
470-be performed, has elected to decline or defer testing. Consent to HIV testing is inferred unless the 19
471-individual declines testing. 20
472-(25) "Perinatal case report for HIV" means the information that is provided to the 21
473-department related to a child aged less than eighteen (18) months born to an HIV-infected mother 22
474-and the child does not meet the criteria for HIV infection or the criteria for "not infected" with HIV 23
475-as defined in the most current surveillance case definition for HIV infection published by the CDC. 24
476-(26) "Person" means any individual, trust or estate, partnership, corporation (including 25
477-associations, joint stock companies), limited liability companies, state, or political subdivision or 26
478-instrumentality of a state. 27
479-(27) "Persons at high risk for HIV infection" means persons defined as being high risk in 28
480-the CDC's most current recommendations for HIV testing of adults, adolescents and pregnant 29
481-women in healthcare settings or through authority and responsibilities conferred on the director by 30
482-law in protecting the public's health. 31
483-(28) "Polymerase chain reaction (PCR) test" means a common laboratory method of 32
484-creating copies of specific fragments of DNA or RNA. 33
485-(29) "Qualified professional HIV test counselor" means: (i) A physician, physician 34
486-
487-
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489-assistant, certified nurse practitioner, midwife, or nurse licensed to practice in accordance with 1
490-applicable state law; (ii) A medical student who is actively matriculating in a medical degree 2
491-program and who performs duties assigned to them by a physician; or (iii) A person who has 3
492-completed an HIV counseling training program, in accordance with regulations hereunder 4
493-promulgated. 5
494-(30) "Sexually transmitted diseases (STD's)" means those diseases included in § 23-11-1, 6
495-as amended, entitled "Sexually Transmitted Diseases," and any other sexually transmitted disease 7
496-that may be required to be reported by the department. 8
497-SECTION 6. This act shall take effect on January 1, 2024. 9
229+LC001940 - Page 7 of 8
230+provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 1
231+provide the patient a list of physicians, clinics or other health care providers to contact regarding 2
232+follow-up care. 3
233+(iii) A pharmacist shall dispense or administer a complete course of a post-exposure 4
234+prophylaxis drug as long as all of the following conditions are met: 5
235+(A) The pharmacist screens the patient and determines that the exposure occurred within 6
236+the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post-7
237+exposure prophylaxis drug under CDC guidelines; 8
238+(B) The pharmacist provides HIV testing to the patient or determines that the patient is 9
239+willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo 10
240+HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection, 11
241+the pharmacist may dispense or administer a post-exposure prophylaxis drug; 12
242+(C) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on 13
243+the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the 14
244+availability of a preexposure prophylaxis drug for persons who are at substantial risk of acquiring 15
245+HIV; and 16
246+(D) The pharmacist notifies the patient's primary care provider of the dispensing or 17
247+administering of the post-exposure prophylaxis drug. If the patient does not have a primary care 18
248+provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall 19
249+provide the patient a list of physicians, clinics or other health care providers to contact regarding 20
250+follow-up care. 21
251+(c) Rules, regulations and protocols. The board shall promulgate rules and regulations 22
252+establishing standards for authorizing pharmacists to prescribe, dispense and administer HIV 23
253+prevention drugs in accordance with subsection (b) of this section, including adequate training 24
254+requirements and protocols for when there is no prescription drug order, standing order or 25
255+collaborative practice agreement. 26
256+SECTION 3. This act shall take effect on January 1, 2024. 27
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258+LC001940
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504263 EXPLANATION
505264 BY THE LEGISLATIVE COUNCIL
506265 OF
507266 A N A C T
508267 RELATING TO INSURANCE -- INSURANCE COVERAGE F OR PREVENTION OF HIV
509268 INFECTION
510269 ***
511270 This act would require coverage for the treatment of pre-exposure prophylaxis (PrEP) for 1
512271 the prevention of HIV and post-exposure prophylaxis (PEP) for treatment of HIV infection, 2
513272 commencing January 1, 2024. 3
514273 This act would take effect on January 1, 2024. 4
515274 ========
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275+LC001940
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277+